Title: Communicate with third-party payers to determine coverage, rejected claims, or prior authorizations.
Course: Pharmacy Technician II (14152-II) > Section: Assisting the Pharmacist in Serving Patients

Communication should be conducted with professionalism through

- telephone
- letter
- email
- faxes
- electronic formats
- mobile devices (e.g., text messages).

See PTCB 8.2, 8.3 (https://www.ptcb.org/lib24watch/files/pdf/169).

See ASHP 3.14 (https://www.ashp.org/-/media/assets/professional-development/technician-program-accreditation/docs/ashp-acpe-pharmacy-technician-accreditation-standard-2018.ashx?la=en&hash=36EAA6511105A6C6BFEA4F30E193892F19E2C385).

Process/Skill Questions:

- What are common reasons for rejected claims?
- What are the most common prior authorization procedures?
- How would a pharmacy technician communicate with patients, third-party payers, and others regarding medication coverage?
- How does HIPAA limit what information may be communicated to the patient regarding rejected claims and cancelled policies?
- What is the pharmacy benefits manager’s role in the adjudication of claims?
- What is the pharmacy benefits manager’s relationship to a third-party payer?